Mycetoma



Mycetoma


Brian J. Hall, MD

Francisco G. Bravo, MD










Mycetoma of the right foot from a patient stationed in Guam demonstrates several draining sinus tracts image (present for months) with tissue swelling and slight hyperpigmentation. (Courtesy J. Steger, MD.)






Although usually more deep-seated, characteristic pale grains of eumycetoma image are seen surrounded by inflammation. (Courtesy S. Florell, MD.)


TERMINOLOGY


Synonyms



  • Madura foot, maduromycosis


Definitions



  • Localized chronic granulomatous infection involving skin, subcutaneous tissue, and occasionally underlying soft tissue and bone; can be caused by either fungi or bacteria


ETIOLOGY/PATHOGENESIS


Infectious Agents



  • Most common causal organisms are either true fungi from class Eumycetes (eumycetomas) or filamentous bacteria from class Actinobacteria (actinomycetomas)



    • In eumycetomas, most common causal agent worldwide is Madurella mycetomatis, although many other species can cause disease



      • In the USA, Pseudallescheria boydii is most common agent


    • In actinomycetomas, Nocardia brasiliensis and Actinomadura madurae are 2 most common isolates


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Unknown due to slow progression and late presentation in most patients


  • Age



    • Most infections occur in patients aged 20-40 years


  • Gender



    • M:F ˜ 4:1


  • Ethnicity



    • Most cases occur in tropical and subtropical populations


    • “Mycetoma belt” includes areas between latitudes 15° south and 30° north



      • Includes India, Mexico, Venezuela, Colombia, Argentina, Sudan Somalia, and Senegal


    • Occasional case report in USA and Europe


    • People involved with fieldwork &/or frequent contact with soil (herdsmen, farmers, field laborers) are more commonly affected


Site



  • Feet most common location (˜ 70%)



    • Other common sites include hands, legs, knee joints, arms


  • Actinomycetomas of shoulder are commonly seen in Mexico, especially in lumber workers carrying logs


Presentation

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Mycetoma
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